Adult Medical Emergency Handbook - Scottish Intensive Care Society

THE PATIENT WHO IS NOT COMPETENT TO MAKE A DECISION
ABOUT RESUSCITATION
• Enquire about previous wishes from the relevant others to help
the clinical team make the most appropriate decision. Continue to
communicate progress to them.
• A Treatment Plan under Section 47 of the Adults with Incapacity
(Scotland) Act must be completed prior to a DNAR decision being
made.
• Continue to communicate progress to the relevant others.
THE ROLE OF THE RELATIVES/RELEVANT OTHERS
• A competent patient’s permission must be sought before any
discussion takes place with the relevant others.
• Relatives should never be given the impression that their wishes
override those of the patient. They can give information about the
patient’s wishes but should not be burdened with the decision unless
their status as proxy for the patient has been legally established.
PATIENTS WITH A DNAR ORDER AT HOME OR BEING
DISCHARGED HOME
• It is the medical and nursing team’s responsibility to ensure that
the family are aware of the existence of the DNAR form and know
what to do in the event of the patient’s death.
• Where it is felt it may be harmful to the patient to have the DNAR
form in the home the GP should keep the form in the front of the
medical notes and ensure that all the healthcare professionals
involved in the patient’s care are aware of this.
• The OOH service must be made aware of the existence of the DNAR
order. Every effort must be made to ensure the emergency services
are not called inappropriately where a patient’s death is expected.
PATIENTS WITH A DNAR ORDER BEING TRANSPORTED BY
AMBULANCE
• The ambulance section of the DNAR form must be completed for
any such patient form being transported in Lothian by the Scottish
Ambulance Service.
• Ambulance control must be informed of the existence of the
DNAR order at the time of booking the ambulance.
30 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11